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Organization

LEGACY DENTAL GROUP PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BRIAN V KERR DMD (OWNER)
(253) 584-6200
Entity
Organization

Contact information

Practice address
9951 MICKELBERRY RD NW, SUITE #215, SILVERDALE, WA 98383-8309
(360) 692-9701
Mailing address
9951 MICKELBERRY RD NW, SUITE #215, SILVERDALE, WA 98383-8309
(360) 692-9701

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1223P0300X
Periodontics
1223S0112X
Oral and Maxillofacial Surgery (Dentist)

Other

Enumeration date
09/20/2012
Last updated
09/20/2012
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